Gait and Balance Rehabilitation

Presentation

Walking is the fundamental functional activity of human beings. Its disruption — whether resulting from physiological aging, stroke, degenerative neurological disease, trauma or surgery — has a considerable impact on autonomy, quality of life and vital prognosis (falls are the leading cause of accidental death in people over 65).

Gait and balance rehabilitation is based on a thorough understanding of the normal gait cycle (stance and swing phases), balance control systems (vestibular, visual, proprioceptive) and their central integration by the nervous system. It employs varied techniques ranging from analytical work to retraining in ecological conditions (outdoor walking, varied terrain, dual-task).

Fundamental Principles

• Gait cycle analysis: normal gait comprises a stance phase (60% of cycle) and a swing phase (40%). Analysis of deviations from the normal cycle guides rehabilitation
• Triple balance control: balance relies on the integration of three afferent systems: vestibular, visual and proprioceptive. The cerebellum and cerebral cortex integrate this information and coordinate motor responses
• Postural strategies: three main strategies maintain standing balance — ankle strategy (minor perturbations on firm surface), hip strategy (larger perturbations or unstable surface) and stepping strategy (last resort to prevent falls)
• Neural plasticity: after neurological injury (stroke, TBI), rehabilitation exploits cerebral plasticity to reorganize neural networks. Repetition, intensity, task specificity and early intervention are key recovery factors
• Multifactorial fall prevention: fall prevention requires global risk factor assessment: muscle strength, balance, visual acuity, medications, home environment, footwear, cognitive and nutritional status

Main Indications

• Post-stroke rehabilitation (hemiplegia, hemiparesis)
• Neurodegenerative diseases (Parkinson's, multiple sclerosis, ALS)
• Vestibular balance disorders
• Fall prevention in elderly (frail or pre-frail geriatric population)
• Lower limb fracture rehabilitation (femoral neck, tibial plateau, ankle)
• Post total hip or knee arthroplasty
• Moderate to severe traumatic brain injury (coordination disorders, ataxia)
• Incomplete spinal cord injury
• Lower limb amputees (prosthetic gait training)
• Peripheral neuropathies (Guillain-Barré, diabetic polyneuropathies)

Typical Session

Assessment (5-10 min): Timed Up and Go (TUG), Tinetti test (POMA score /28), Berg Balance Scale (/56), 10-meter walk speed test, 6-minute walk test, observational gait analysis.

Static balance work (10 min): Standing with eyes open then closed, bipedal then unipedal, stable then unstable surfaces (foam, wobble board, Bosu). Manual destabilization with postural reactions.

Dynamic balance and transfers (10 min): Sit-to-stand transfers with weight-bearing symmetry control, lateral displacement, tandem walking, obstacle negotiation, turning.

Gait retraining (15-20 min): Treadmill walking with or without body weight support, spatiotemporal parameter work (step length, width, cadence, speed), specific gait deviation correction, varied conditions (slopes, stairs, irregular terrain), cognitive dual-task walking.

Targeted strengthening (10 min): Key gait muscles: quadriceps, hamstrings, gluteus medius, triceps surae, ankle dorsiflexors. Functional exercises: squats, step-ups, lunges, calf raises.

Contraindications

• Non-consolidated lower limb fracture
• Severe hemodynamic instability (major symptomatic orthostatic hypotension, decompensated heart failure)
• Acute stroke with neurological instability
• Recent untreated deep vein thrombosis
• Acute unstabilized vestibular vertigo (high fall risk)
• Severe cognitive impairment preventing active participation
• Altered general health status (fever, acute infection, shock)